The present application is directed to novel compounds formed by chemically coupling diphenylethylene compounds and derivatives thereof with thiazolidine or oxazolidine intermediates. These compounds are effective for providing a variety of useful pharmacological effects. For example, the compounds are useful in lowering blood glucose, serum insulin and triglyceride levels in animal models of type II diabetes. Surprisingly, these compounds have been found to increase the leptin level and have no liver toxicity.
Furthermore, these compounds are useful for treatment of disorders associated with insulin resistance, such as polycystic ovary syndrome, as well as hyperlipidemia, coronary artery disease and peripheral vascular disease, and for the treatment of inflammation and immunological diseases, particularly those mediated by cytokines and cyclooxygenase such as TNF-alpha, IL-1, IL-6 and/or COX-2.
The causes of type I and type II diabetes are yet unknown, although both genetics and environment seem to be major factors. Insulin dependent type I and non-insulin dependent type II are the types which are known. Type I is an autoimmune disease in which the responsible autoantigen is still unknown. Patients of type I need to take insulin parenterally or subcutaneously to survive. However, type II diabetes, the more common form, is a metabolic disorder resulting from the body's inability to make a sufficient amount of insulin or to properly use the insulin that is produced. Insulin secretion and insulin resistance are considered the major defects, however, the precise genetic factors involved in the mechanism remain unknown.
Patients with diabetes usually have one or more of the following defects:                Less production of insulin by the pancreas;        Over secretion of glucose by the liver;        Independent of the glucose uptake by the skeletal muscles;        Defects in glucose transporters, desensitization of insulin receptors; and        Defects in the metabolic breakdown of polysaccharides.        
Other than the parenteral or subcutaneous application of insulin, there are about 4 classes of oral hypoglycemic agents used.
ApprovedClassDrugsMechanisms ofLimitationsSulfonylurea4 (1stacts on pancreasdevelopment ofgeneration)to release moreresistanceandinsulin2 (2ndgeneration)BiguanidesMetforminreduces glucoseliver problems,production bylactic acidosisliver; improvesinsulin sensitivityAlpha-Acarboseinterferes withonly useful atglucosidasedigestivepost-prandialinhibitorprocess; reduceslevelglucoseabsorptionThiazolidinedioneTroglitazonereduce insulin“add-on” with(withdrawn)resistancyinsulin; not usefulrosiglitazonefor people withpioglitazoneheart and liverdisease
As is apparent from the above table, each of the current agents available for use in treatment of diabetes has certain disadvantages. Accordingly, there is a continuing interest in the identification and development of new agents, particularly, water soluble agents which can be orally administered, for use in the treatment of diabetes.
The thiazolidinedione class listed in the above table has gained more widespread use in recent years for treatment of type II diabetes, exhibiting particular usefulness as insulin sensitizers to combat “insulin resistance”, a condition in which the patient becomes less responsive to the effects of insulin. However, the known thiazolidinediones are not effective for a significant portion of the patient population. In addition, the first drug in this class to be approved by the FDA, troglitazone, was withdrawn from the market due to problems of liver toxicity. Thus, there is a continuing need for nontoxic, more widely effective insulin sensitizers.
Pharmaceutical compositions and methods utilizing thiazolidinediones are described in U.S. Pat. Nos. 6,133,295; 6,133,293; 6,130,216; 6,121,295; 6,121,294; 6,117,893; 6,114,526; 6,110,951; 6,110,948; 6,107,323; 6,103,742; 6,080,765; 6,046,222; 6,046;202; 6,034,110; 6,030,973; RE36,575; 6,011,036; 6,011,031; 6,008,237; 5,990,139; 5,985,884; 5,972,973 and others.
As indicated above, the present invention is also concerned with treatment of immunological diseases or inflammation, notably such diseases as are mediated by cytokines or cyclooxygenase. The principal elements of the immune system are macrophages or antigen-presenting cells, T cells and B cells. The role of other immune cells such as NK cells, basophils, mast cells and dendritic cells are known, but their role in primary immunologic disorders is uncertain. Macrophages are important mediators of both inflammation and providing the necessary “help” for T cell stimulation and proliferation. Most importantly macrophages make IL 1, IL 12 and TNFα all of which are potent pro-inflammatory molecules and also provide help for T cells. In addition, activation of macrophages results in the induction of enzymes, such as cyclooxygenase II (COX-2), inducible nitric oxide synthase (iNOS) and production of free radicals capable of damaging normal cells. Many factors activate macrophages, including bacterial products, superantigens and interferon gamma (IFNγ). It is believed that phosphotyrosine kinases (PTKs) and other undefined cellular kinases are involved in the activation process.
Macrophages take up and break down antigens into small fragments. These fragments then associate with the major histocompatibility complex II (MHC II). This complex of antigen fragments and MHC II is recognized by the T cell receptor. In association with appropriate co-stimulatory signals this receptor-ligand interaction leads to the activation and proliferation of T cells. Depending on the route of administration of antigen, their dose and the conditions under which macrophages are activated, the immune response can result in either B cell help and antibody production or on the development of cell mediated response. Since macrophages are sentinel to the development of an immune response, agents that modify their function, specifically their cytokine secretion profile, are likely to determine the direction and potency of the immune response.
Cytokines are molecules secreted by immune cells that are important in mediating immune responses. Cytokine production may lead to the secretion of other cytokines, altered cellular function, cell division or differentiation. Inflammation is the body's normal response to injury or infection. However, in inflammatory diseases such as rheumatoid arthritis, pathologic inflammatory processes can lead to morbidity and mortality. The cytokine tumor necrosis factor-alpha (TNF-alpha) plays a central role in the inflammatory response and has been targeted as a point of intervention in inflammatory disease. TNF-alpha is a polypeptide hormone released by activated macrophages and other cells. At low concentrations, TNF-alpha participates in the protective inflammatory response by activating leukocytes and promoting their migration to extravascular sites of inflammation (Moser et al., J Clin Invest, 83:444–55, 1989). At higher concentrations, TNF-alpha can act as a potent pyrogen and induce the production of other pro-inflammatory cytokines (Haworth et al., Eur J Immunol, 21:2575–79, 1991; Brennan et al., Lancet, 2:244–7, 1989). TNF-alph also stimulates the synthesis of acute-phase proteins. In rheumatoid arthritis, a chronic and progressive inflammatory disease affecting about 1% of the adult U.S. population, TNF-alpha mediates the cytokine cascade that leads to joint damage and destruction (Arend et al., Arthritis Rheum, 38:151–60, 1995). Inhibitors of TNF-alpha, including soluble TNF receptors (etanercept) (Goldenberg, Clin Ther, 21:75–87, 1999) and anti-TNF-alpha antibody (infliximab) (Luong et al., Ann Pharmacother, 34:743–60, 2000), have recently been approved by the U.S. Food and Drug Administration (FDA) as agents for the treatment of rheumatoid arthritis.
Elevated levels of TNF-alpha have also been implicated in many other disorders and disease conditions, including cachexia (Fong et al., Am J Physiol, 256:R659–65, 1989), septic shock syndrome (Tracey et al., Proc Soc Exp Biol Med, 200:233–9, 1992), osteoarthritis (Venn et al., Arthritis Rheum, 36:819–26, 1993), inflammatory bowel disease such as Crohn's disease and ulcerative colitis (Murch et al., Gut, 32:913–7, 1991), Behcet's disease (Akoglu et al., J Rheumatol, 17:1107–8, 1990), Kawasaki disease (Matsubara et al., Clin Immunol Immunopathol, 56:29–36, 1990), cerebral malaria (Grau et al., N Engl J Med, 320:1586–91, 1989), adult respiratory distress syndrome (Millar et al., Lancet 2:712–4, 1989), asbestosis and silicosis (Bissonnette et al., Inflammation, 13:329–39, 1989), pulmonary sarcoidosis (Baughman et al., J Lab Clin Med, 115:36–42, 1990), asthma (Shah et al., Clin Exp Allergy, 25:1038–44 , 1995), AIDS (Dezube et al., J Acquir Immune Defic Syndr, 5:1099–104, 1992), meningitis (Waage et al., Lancet, 1:355–7, 1987), psoriasis (Oh et al., J Am Acad Dermatol, 42:829–30, 2000), graft versus host reaction (Nestel et al., J Exp Med, 175:405–13, 1992), multiple sclerosis (Sharief et al., N Engl J Med, 325:467–72, 1991), systemic lupus erythematosus (Maury et al., Int J Tissue React, 11:189–93, 1989), diabetes (Hotamisligil et al., Science, 259:87–91, 1993) and atherosclerosis (Bruunsgaard et al., Clin Exp Immunol, 121:255–60, 2000).
It can be seen from the references cited above that inhibitors of TNF-alpha are potentially useful in the treatment of a wide variety of diseases. Compounds that inhibit TNF-alpha have been described in U.S. Pat. Nos. 6,090,817; 6,080,763; 6,080,580; 6,075,041; 6,057,369; 6,048,841; 6,046,319; 6,046,221; 6,040,329; 6,034,100; 6,028,086; 6,022,884; 6,015,558; 6,004,974; 5,990,119; 5,981,701; 5,977,122; 5,972,936; 5,968,945; 5,962,478; 5,958,953; 5,958,409; 5,955,480; 5,948,786; 5,935,978; 5,935,977; 5,929,117; 5,925,636; 5,900,430; 5,900,417; 5,891,883; 5,869,677 and others.
Interleukin-6 (IL-6) is another pro-inflammatory cytokine that exhibits pleiotropy and redundancy of action. IL-6 participates in the immune response, inflammation and hematopoiesis. It is a potent inducer of the hepatic acute phase response and is a powerful stimulator of the hypothalamic-pituitary-adrenal axis that is under negative control by glucocorticoids. IL-6 promotes the secretion of growth hormone but inhibits release of thyroid stimulating hormone. Elevated levels of IL-6 are seen in several inflammatory diseases, and inhibition of the IL-6 cytokine subfamily has been suggested as a strategy to improve therapy for rheumatoid arthritis (Carroll et al., Inflamm Res, 47:1–7, 1998). In addition, IL-6 has been implicated in the progression of atherosclerosis and the pathogenesis of coronary heart disease (Yudkin et al., Atherosclerosis, 148:209–14, 1999). Overproduction of IL-6 is also seen in steroid withdrawal syndrome, conditions related to deregulated vasopressin secretion, and osteoporosis associated with increased bone resorption, such as in cases of hyperparathyroidism and sex-steroid deficiency (Papanicolaou et al., Ann Intern Med, 128:127–37, 1998).
Since excessive production of IL-6 is implicated in several disease states, it is highly desirable to develop compounds that inhibit IL-6 secretion. Compounds that inhibit IL-6 have been described in U.S. Pat. Nos. 6,004,813; 5,527,546 and 5,166,137.
Cyclooxygenase is an enzyme that catalyzes a rate-determining step in the biosynthesis of prostaglandins, which are important mediators of inflammation and pain. The enzyme occurs as at least two distinct isomers, cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). The COX-1 isomer is constitutively expressed in the gastric mucosa, platelets and other cells and is involved in the maintenance of homeostasis in mammals, including protecting the integrity of the digestive tract. The COX-2 isomer, on the other hand, is not constitutively expressed but rather is induced by various agents, such as cytokines, mitogens,. hormones and growth factors. In particular, COX-2 is induced during the inflammatory response (DeWitt DL, Biochim Biophys Acta, 1083:121–34, 1991; Seibert et al., Receptor, 4:17–23, 1994.). Aspirin and other conventional non-steroid anti-inflammatory drugs (NSAIDs) are non-selective inhibitors of both COX-1 and COX-2. They can be effective in reducing inflammatory pain and swelling, but since they hamper the protective action of COX-1, they produce undesirable side effects of gastrointestinal pathology. Therefore, agents that selectively inhibit COX-2 but not COX-1 are preferable for treatment of inflammatory diseases. Recently, a diarylpyrazole sulfonamide (celecoxib) that selectively inhibits COX-2 has been approved by the FDA for use in the treatment of rheumatoid arthritis (Luong et al., Ann Pharmacother, 34:743–60, 2000; Penning et al., J Med Chem, 40:1347–65, 1997). COX-2 is also expressed in many cancers and precancerous lesions, and there is mounting evidence that selective COX-2 inhibitors may be useful for treating and preventing colorectal, breast and other cancers (Taketo M M, J Natl Cancer Inst, 90:1609–20, 1999; Fournier et al., J Cell Biochem Suppl, 34:97–102, 2000; Masferrer et al., Cancer Res., 60:1306–11, 2000). In 1999 celecoxib was approved by the FDA as an adjunct to usual care for patients with familial adenomatous polyposis, a condition which, left untreated, generally leads to colorectal cancer.
Compounds that selectively inhibit COX-2 have been described in U.S. Pat. Nos. 5,344,991; 5,380,738; 5,434,178; 5,466,823; 5,474,995; 5,510,368; 5,521,207; 5,521,213; 5,536,752; 5,550,142; 5,552,422; 5,604,260; 5,639,780; 5,643,933; 5,677,318; 5,691,374; 5,698,584; 5,710,140; 5,733,909; 5,789,413; 5,811,425; 5,817,700; 5,849,943; 5,859,257; 5,861,419; 5,905,089; 5,922,742; 5,925,631; 5,932,598; 5,945,539; 5,968,958; 5,981,576; 5,994,379; 5,994,381; 6,001,843; 6,002,014; 6,004,950; 6,004,960; 6,005,000; 6,020,343; 6,034,256; 6,046,191; 6,046,217; 6,057,319; 6,071,936; 6,071,954; 6,077,850; 6,077,868; 6,077,869 and 6,083,969.
The cytokine IL-1 beta also participates in the inflammatory response. It stimulates thymocyte proliferation, fibroblast growth factor activity, and the release of prostaglandin from synovial cells.
Elevated or unregulated levels of the cytokine IL-1 beta have been associated with a number of inflammatory diseases and other disease states, including but not limited to adult respiratory distress syndrome (Meduri et al, Chest 107:1062–73, 1995), allergy (Hastie et al, Cytokine 8:730–8, 1996), Alzheimer's disease (O'Barr et al, J Neuroimmunol 109:87–94, 2000), anorexia (Laye et al, Am J Physio: Regul Integr Comp Physiol 279:R93–8, 2000), asthma (Sousa et al, Thorax 52:407–10, 1997), atherosclerosis (Dewberry et al, Arterioscler Thromb Vasc Biol 20:2394–400, 2000), brain tumors (Ilyin et al, Mol Chem Neuropathol 33:125–37, 1998), cachexia (Nakatani et al, Res Commun Mol Pathol Pharmacol 102:241–9, 1998), carcinoma (Ikemoto et al, Anticancer Res 20:317–21, 2000), chronic arthritis (van den Berg et al, Clin Exp Rheumatol 17: S105–14, 1999), chronic fatigue syndrome (Cannon et al, J Clin Immunol 17:253–61, 1997), CNS trauma (Herx et al, J Immunol 165:2232–9, 2000), epilepsy (De Simoni et al, Eur J Neurosci 12:2623–33, 2000), fibrotic lung diseases (Pan et al, Pathol Int 46:91–9, 1996), fulminant hepatic failure (Sekiyama et al, Clin Exp Immunol 98:71–7, 1994), gingivitis (Biesbrock et al, Monogr Oral Sci 17:20–31, 2000), glomerulonephritis (Kluth et al, J Nephrol 12:66–75, 1999), Guillain-Barre syndrome (Zhu et al, Clin Immunol Immunopathol 84:85–94, 1997), heat hyperalgesia (Opree et al, J Neurosci 20:6289–93, 2000), hemorrhage and endotoxemia (Parsey et al, J Immunol 160:1007–13, 1998), inflammatory bowel disease (Olson et al, J Pediatr Gastroenterol Nutr 16:241–6, 1993), leukemia (Estrov et al, Leuk Lymphoma 24:379–91, 1997), leukemic arthritis (Rudwaleit et al, Arthritis Rheum 41:1695–700, 1998), systemic lupus erythematosus (Mao et al, Autoimmunity 24:71–9, 1996), multiple sclerosis (Martin et al, J Neuroimmunol 61:241–5, 1995), osteoarthritis (Hernvann et al, Osteoarthritis Cartilage 4:139–42, 1996), osteoporosis (Zheng et al, Maturitas 26:63–71, 1997), Parkinson's disease (Bessler et al, Biomed Pharmacother 53:141–5, 1999), POEMS syndrome (Gherardi et al, Blood 83:2587–93, 1994), pre-term labor (Dudley, J Reprod Immunol 36:93–109, 1997), psoriasis (Bonifati et al, J Biol Regul Homeost Agents 11:133–6, 1997), reperfusion injury (Clark et al, J Surg Res 58:675–81, 1995), rheumatoid arthritis (Seitz et al, J Rheumatol 23:1512–6, 1996), septic shock (van Deuren et al, Blood 90:1101–8, 1997), systemic vasculitis (Brooks et al, Clin Exp Immunol 106:273–9, 1996), temporal mandibular joint disease (Nordahl et al, Eur J Oral Sci 106:559–63, 1999), tuberculosis (Tsao et al, Tuber Lung Dis 79:279–85, 1999), viral rhinitis (Roseler et al, Eur Arch Otorhinolaryngol Suppl 1:S61–3, 1995), and pain and/or inflammation resulting from strain, sprain, trauma, surgery, infection or other disease processes.
Since overproduction of IL-1 beta is associated with numerous disease conditions, it is desirable to develop compounds that inhibit the production or activity of IL-1 beta. Methods and compositions for inhibiting IL-1 beta are described in U.S. Pat. Nos. 6,096,728; 6,090,775; 6,083,521; 6,036,978; 6,034,107; 6,034,100; 6,027,712; 6,024,940; 5,955,480; 5,922,573; 5,919,444; 5,905,089; 5,874,592; 5,874,561; 5,874,424; 5,840,277; 5,837,719; 5,817,670; 5,817,306; 5,792,778; 5,780,513; 5,776,979; 5,776,954; 5,767,064; 5,747,444; 5,739,282; 5,731,343; 5,726,148; 5,684,017; 5,683,992; 5,668,143; 5,624,931; 5,618,804; 5,527,940; 5,521,185; 5,492,888; 5,488,032 and others.
It will be appreciated from the foregoing that, while there have been extensive prior efforts to provide compounds for inhibiting, for example, TNF-alpha, IL-1, IL-6, COX-2 or other agents considered responsible for immune response, inflammation or inflammatory diseases, e.g. arthritis, there still remains a need for new and improved compounds for effectively treating or inhibiting such diseases. A principal object of the invention is to provide compounds which are effective for such treatments as well as for the treatment of, for example, insulin resistance, hyperlipidemia, coronary heart disease, multiple sclerosis and cancer.